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SNF/OA109 Recoupments
Many providers have been receiving recoupment notices from claims that are 2-3 years old recently. Here is what CIGNA has to say:
"Recently it was identified that some claims that were included on the IUR Report were not being included in the overpayment requests due to file size restraints. The Centers for Medicare and Medicaid Services (CMS) instructed us to clear out all IUR overflow files and generate overpayment requests. This has resulted in overpayment requests for claims with dates of service as old as 2007. All remaining Jurisdiction C Overpayment requests due to the IUR overflow issue will be sent out by August 20, 2010. The IUR file size capacity has been expanded to prevent the overflow issue from occurring in the future. Note that you may still receive SNF overpayment requests in the future, but when you do they will be more current."
CO-184 Denials
You have noticed denials the code CO-184 starting on checks dated July 1 and after. This denial indicates that the referring/ordering physician is not eligible to refer/order DME for a patient, therefore denying the claim. NAIMES, the National Association of Independent Medical Equipment Suppliers, sent out an e-mail July 2 that quoted from correspondence a member had received from CIGNA indicating that the denial code was an error on CIGNA's part and that all affected claims would be re-processed. Keep a careful watch on your claims that deny with this code to insure they are re-processed.
PECOS
PECOS has been postponed again until January of 2011--or so it seemed until recently. CMS has not really clarified the issue of claims that are submitted after July 6, 2010, with referring/ordering physicians who are not PECOS enrolled. Some industry experts had indicated that you could be subject to False Claims if you submitted claims with non-PECOS enrolled docs after July6. CMS issued a press release July 2 that indicated the deadline was still January 2011, but it wasn't crystal clear. Stay tuned for more in this issue. It is still imperative that you insure that all referring physcians are enrolled in PECOS, though, to insure that claims won't deny beginning January of 2011.
KE MODIFIER
The KE modifier is used on codes that were subject to competitive bidding in postponed round one, and then were cut 9.5% in January of 2009. IF YOU BILL AN ITEM, TYPICALLY A WHEELCHAIR ACCESSORY, FOR USE ON AN ITEM THAT WAS NOT SUBJECT TO COMPETITIVE BIDDING, THE 9.5% REDUCTION DOES NOT APPLY!
For example, the code K0195 was subject to competitive bidding. When you bill that code with K0001(2)(3)(4), though, it is not subject to the 9.5% reduction in the fee schedule amount. You use the KE modifier to communicate that to Medicare. Check the on-line fee schedule for codes with the KE modifier...
Click here for a chart of the codes you need to watch for, courtesy US Rehab.
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